Medicaid expansion

Sen. Lincoln Hough is the latest guest on the Politically Speaking podcast. The Springfield Republican talked with St. Louis Public Radio’s Jason Rosenbaum and Jaclyn Driscoll about the upcoming special session — and what to expect when lawmakers come back to Jefferson City in January.

Hough represents Missouri’s 30th Senatorial District, which takes in a big chunk of Springfield and Greene County. He was sworn into office in early January for a four-year term.

Proponents of a Medicaid expansion in Missouri want to allow voters to override the state's Republican leaders, who have refused to extend coverage to more people.

The Healthcare for Missouri coalition is collecting signatures on a petition that would place a Medicaid expansion on the November 2020 ballot. If approved by voters, Missouri would expand the health insurance program to those who earn up to $18,000 a year. Missouri is one of 14 states that has not made the program available to more low-income people.

Campaign organizers say the expansion is necessary to extend health care coverage to people who have jobs but lack health insurance.

Missouri likely would not have to spend any additional money to expand Medicaid to insure more low-income people, according to a report from the Washington University Center on Health Economics and Policy.

The state spends nearly $4 billion to provide Medicaid to people with disabilities, pregnant women, children and some seniors.

Researchers say adding people who make up to 138 percent of the federal poverty rate – close to $17,000 annually – likely wouldn’t cost Missouri extra funds, because the state would receive increased federal funding under a Medicaid expansion.

Health care advocates in Kansas and Missouri are hopeful that 2019 will be the year that hundreds of thousands of people can get health care coverage through expansion of Medicaid.

It’s been blocked in both states by Republicans who question the price tag, but now that many states have had expanded Medicaid for several years, there’s a small but growing body of evidence about its actual costs.

Rural hospitals are more likely to close in states such as Missouri that have not expanded Medicaid.

A recent report from the pro-Affordable Care Act organization Protect Our Care analyzed 84 rural hospital closures since 2010. It found 90 percent of those hospital closures were in states that had not expanded Medicaid coverage. Missouri remains one of the 14 states that hasn’t amended its program to cover people who earn up to 138 percent above the poverty line.

Missouri and Kansas have joined 18 other states in seeking to have the Affordable Care Act declared unconstitutional following Congress’ repeal last year of the tax penalty associated with the individual mandate.

In a lawsuit filed late Monday in federal court in Texas, the coalition of 20 mostly red states claimed that the elimination of the tax penalty for those who don’t buy health insurance renders the entire healthcare law unconstitutional.

MONROE CITY, MO. — The closest emergency room is 20 miles east on the highway. That’s why it isn’t unusual for people experiencing heart attacks, blood clots and strokes to show up at Dr. Rodney Yager’s clinic on Main Street in Monroe City.

Yager, who grew up in the area, can handle the fast pace of a small-town clinic. What worries him more is how federal health care policies being shaped in Washington, D.C., could affect his patients.

A Republican proposal to gut the Affordable Care Act narrowly passed the U.S. House of Representatives and now the U.S. Senate is crafting its own bill to reshape the nation’s health care system. Elected officials have held few town halls to hear from constituents in the St. Louis area about what they want in a health care bill, sparking demonstrations outside representatives’ offices.

Drive down a dirt road in Dallas County, under a thick canopy of walnut trees and over three cattle guards, and you’ll come to Rachel Harrison’s home in Windyville, Missouri.

A few years ago, Harrison was using her Bachelor’s degree in biology in a hospital laboratory.

“I was a generalist, which means I was in charge of urinalysis, chemistry, special chemistry, hematology, blood banking, coagulation, I think I got it all—phlebotomy, all that kind of stuff,” Harrison said.

It's a split decision in the trial of the so-called "Medicaid 23," a group of religious leaders who staged a protest in the Missouri Senate more than two years ago over lawmakers' refusal to expand Medicaid.

Twenty-two members of the group were found guilty of trespassing for not leaving the Senate gallery when ordered to do so by Capitol police. But they were found not guilty of obstructing the operations of the Senate. The case of one other member will be decided later.

In our weekly "Behind the Headlines" segment, “St. Louis on the Air” host Don Marsh discussed several of the top news stories that caught St. Louisans’ attention this week, with the people that produced them and influenced them.

Despite the efforts of healthcare advocates, hospitals and notable former legislators, the Missouri legislature did not pass Medicaid expansion this year, or even bring it to the debate floor. That means an estimated 147,000 Missourians will have another year without health coverage, and the community health clinics that care for the uninsured will continue trying to bridge the gap.

As U.S. Sen. Claire McCaskill sees it, the Missouri General Assembly will be sharing more of the blame as the state’s medical professionals find it more difficult to provide the services and funding needed to care for Missouri’s growing elderly population.

After two years of failing to convince Republican lawmakers to expand Medicaid in Missouri, Gov. Jay Nixon is pitching an alternative he hopes will sway enough of them to come aboard. But key Republicans remain cool to the idea.

Nixon, a Democrat, unveiled his new proposal Wednesday at appearances in Springfield and Kansas City.

Administrators for Missouri’s Medicaid program told members of their oversight committee that they are getting closer to fixing their processing delays for new applicants. But the wait can still take months.

“We are now under 13,000 pending applications. I think we will get into that normal, historical range within the next week,” said Family Support Division Director Alyson Campbell at an oversight committee meeting of MO HealthNet, the social services division that administers Medicaid in Missouri.

Advocates continue to push for the expansion of Medicaid to include Missourians who fall in the so-called “coverage gap.”

Because Missouri has so far opted out of Medicaid expansion under the Affordable Care Act, thousands of Missourians fall into a gap -- they make too much money to qualify for Medicaid, but not enough to qualify for federal aid on the healthcare exchange.

State legislators have made it clear that expansion is unlikely to happen this year either.

The state agency that provides Medicaid coverage to more than 840,000 Missourians does not have proper oversight over contractors in charge of certain aspects of payment processing, according to an audit released Monday of MO HealthNet.

To date, Missouri has failed to expand its Medicaid program as part of the Affordable Care Act, aka "Obamacare." As a result, federal dollars that would normally flow to underserved areas are being transferred to states that have expanded their programs. This loss of funding has major implications for health care in our state especially for those in areas of poverty and who are underserved. One particularly susceptible area is rural Missouri.

As the state – and his reputation – seeks to move beyond Ferguson, Missouri Gov. Jay Nixon is rekindling his longstanding pitch in favor of expanding Medicaid.

And Nixon may be seeking to subtly link the expansion with Ferguson’s headline-grabbing racial and economic unrest, by emphasizing what the state has been giving up in federal money – and what he said has resulted in less help to those who need it.

He didn’t succeed. Despite the attempts of several Republicans in the House and Senate to pass some form of expansion this year, Bond told St. Louis Public Radio on Monday that “we were just a few filibustering senators short of getting it done.”

Twenty-three people were arrested at the Missouri Capitol Tuesday following a protest supporting Medicaid expansion. The protesters began shouting slogans and singing songs from the public gallery above the State Senate floor during debate on an unrelated bill.